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Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)
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Psychiatry 5th year, 5th lecture (Dr. Saman Anwar)

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The lecture has been given on Apr. 5th, 2011 by Dr. Saman Anwar.

The lecture has been given on Apr. 5th, 2011 by Dr. Saman Anwar.

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  • 1. Sexual and gender identity disorders<br />Dr.Saman Anwar<br />M.B.Ch.B, F.I.B.M.S(PSYCH)<br />
  • 2. What Is “Normal” vs. “Abnormal” Sexual Behavior?<br />Cultural considerations<br />Gender differences in sexual behavior and attitudes .<br />Age<br />Individual ability and difference and preference.<br />Life stress, education, love,……etc.<br />NO CUT LINE BETWEEN THE TWO!!!!!!!!<br />
  • 3. Sexual Response Cycle<br />Desire - inc. fantasies<br />Excitement - subjective pleasure, physiological changes.<br />**Plateau: brief pleasurable period of time before orgasm.**<br />Orgasm - peaking of pleasure, ejaculation or vaginal wall contractions<br />Resolution - differs for sexes, refractory period<br />Sexual Dysfunctions at any of first 3 <br />
  • 4. SEXUAL RESPONSE CYCLE<br />
  • 5. Common sexual myths<br />Men should not express their emotions.<br />All physical contact must lead to sex.<br />Good sex leads to a wild orgasm.<br />Sex = intercourse.<br />The man should be the sexual leader.<br />Women should not initiate sex.<br />Men feel like sex all the time.<br />Women should always have sex when her partner makes sexual approaches.<br />Sex is something we instinctively know about.<br />Respectable people should not enjoy sex too much and certainly never masturbate.<br />All other couples have (great)sex, several times a week, have an orgasm every time, and always orgasm simultaneously.<br />If sex is not good, there is something wrong with the relationship.<br />
  • 6. Sexual Dysfunctions: An Overview<br />Sexual Dysfunctions <br />Affect desire, arousal, and/or orgasm<br />Pain associated with sex can lead to additional dysfunction<br />Males and Females <br />Experience parallel versions of most sexual dysfunctions<br />Affects about 43% of all females and 31% of males<br />Most prevalent class of disorder in the United States<br />Classification of Sexual Dysfunctions<br />Lifelong vs. acquired<br />Generalized vs. specific<br />Psychological factors alone<br />Psychological factors combined with medical conditions<br />
  • 7. Sexual Desire Disorders<br />Hypoactive Sexual Desire Disorder<br />Little or no interest in any type of sexual activity<br />Masturbation, sexual fantasies, and intercourse are rare <br />Accounts for half of all complaints at sexuality clinics<br />Affects 22% of women and 5% of men<br />Sexual Aversion Disorder<br />Little interest in sex <br />Physical / sexual contact – Extreme fear, panic, disgust<br />10% of males report panic attacks during sexual activity<br />
  • 8. Excessive sexual desire<br />Occasionally increased sexual drive may occur, presenting as a problem for individuals, partners (on whom (unreasonable)demands are made), or careers (when sexual disinhibition occurs). Referred to as nymphomania (women) or satyriasis (men). Usually occurs in late teenage/early adulthood, secondary to a mood disorder (e.g. mania), in the early stages of dementia, associated with learning disability, secondary to brain injury, or as a side-effect of some drugs.<br />Management Treatment should address any primary problem, general relationship issues. When the problem is persistent, specialist referral may be appropriate (for cognitive, behavioural, or, rarely, pharmacological therapy).<br />
  • 9. Sexual Arousal Disorders<br />Male Erectile Disorder(IMPOTENCE)<br />Difficulty achieving and maintaining an erection.<br />may be secondary to alcohol, diabetes.<br />Female Sexual Arousal Disorder<br />Difficulty achieving and maintaining adequate lubrication<br />Associated Features of Sexual Arousal Disorders<br />Problem is arousal, not desire<br />Affects about 5% of males, 14% of females<br />Males are more troubled by the problem than females<br />Erectile problems are the main reason males seek help <br />
  • 10. Orgasm Disorders<br />Inhibited Orgasm: Female and Male Orgasmic Disorder<br />Have adequate desire and arousal<br />Unable to achieve orgasm <br />Rare condition in adult males<br />Most common complaint of adult females<br />25% of adult females report difficulty reaching orgasm<br />Anxiety based?<br />Retarded Ejaculation - usually no orgasm w/ partner, only masturbation.<br />Premature Ejaculation<br />Ejaculation before the man or partner wishes it to<br />21% of all adult males meet diagnostic criteria<br />Most prevalent sexual dysfunction in adult males<br />Common in younger, inexperienced males<br />Problem declines with age<br />
  • 11. Sexual Pain Disorders<br />Defining Feature<br />Marked pain during intercourse<br />Dyspareunia<br />Extreme pain during intercourse<br />Adequate sexual desire, arousal, and ability to attain orgasm<br />Must rule out medical reasons for pain<br />Affects 1% to 5% of men and about 10% to 15% of women.<br />Vaginismus - involuntary contraction of muscles of outer third of vagina (5-17% of women)<br /> Related to sexual abuse?<br />
  • 12. Management<br />Exclude physical causes of pain (e.g. infection, tender episiotomy scar, endometriosis, ovarian cyst).<br />Provide information about ensuring adequate arousal, variation of intercourse positions to avoid (deep) penetration.<br />Relaxation techniques (including Kegel's exercises) and (positive self-talk)may help reduce anxiety and ensure the woman feels (in control).<br />Where deep pain is experienced after intercourse, this may be due to pelvic congestion syndrome (with symptoms similar to pre-menstrual syndrome) caused by accumulation of blood during arousal without occurrence of orgasm. Achieving orgasm (by intercourse, masturbation, or use of a vibrator) may help to alleviate this congestion.<br />For complex cases, with vague or intermittent problems, associated secondary sexual or psychiatric problems, or when initial treatment is unsuccessful, referral to a specialist is indicated.<br />
  • 13. Causes of Sexual Dysfunctions<br />Biological Contributions <br />Physical disease and medical illness<br />Prescription medications<br />Use and abuse of alcohol and other drugs<br />Psychological Contributions<br />The role of “anxiety” vs. “distraction”<br />The nature and components of performance anxiety<br />Psychological profiles associated with sexual dysfunction <br />Social and Cultural Contributions<br />Negative scripts about sexuality<br />Erotophobia – Learned negative attitudes about sexuality <br />Negative or traumatic sexual experiences <br />Poor interpersonal relationships, lack of communication<br />
  • 14. Medical Treatment of Sexual Dysfunction<br />Erectile Dysfunction<br />Viagra – Is it really the wonder drug?<br />Injection of vasodilating drugs into the penis<br />Penile prosthesis or implants<br />Vascular surgery<br />Vacuum device therapy<br />Few Medical Procedures for Female Sexual Dysfunction<br />Sex hormones: testosterone?!<br />
  • 15. Paraphilias<br />Recurrent, intense sexually arousing fantasies, urges, or behaviors involving nonhumans, suffering of self or partner, children. (For some these are necessary for erotic arousal & always inc. in sexual activity; for other these occur episodically.)<br />Main Types of Paraphilias<br />Fetishism<br />Voyeurism<br />Exhibitionism<br />Transvestic fetishism<br />Sexual sadism and masochism<br />Pedophilia <br />
  • 16. Fetishism<br />Sexual attraction – Nonliving objects<br />Objects can be inanimate and/or tactile<br />Examples include rubber, hair, shoes, underwears, <br />Usually many objects of fetishistic arousal, fantasy, urges<br />Voyeurism<br />Observing an unsuspecting individual undressing or naked<br />Risk associated with “peeping” is necessary for arousal <br />
  • 17. Exhibitionism<br /> exposing genitals to (unsuspecting) stranger(s), most common sex crime in U.S., rare outside, involves shock & risk, often distant from victim, needs to display masculinity w/o having to perform. Element of thrill and risk are necessary for sexual arousal.<br />Transvestic Fetishism<br />Sexual arousal with the act of cross-dressing<br />Males may show highly masculine compensatory behaviors<br />Most do not show compensatory behaviors<br />Many are married and the behavior is known to spouse.<br />Frotteurism<br /> rubbing against nonconsenter( in tram way, bus, lines, crowd places). More common in young adults and could occur in females.<br />
  • 18. Sexual Sadism and Sexual Masochism<br />Sexual Sadism<br />Inflicting pain or humiliation to attain sexual gratification<br />Sexual Masochism<br />Suffer pain or humiliation to attain sexual gratification<br />Relation Between Sadism and Rape<br />Some rapists are sadists<br />Most rapists do not show paraphilic patterns of arousal<br />Sexual arousal to violent sexual and non-sexual material<br />
  • 19. Pedophilia<br />Pedophiles – Sexual attraction to young children <br />Incest – Sexual attraction to one’s own children<br />Victims are typically children or young adolescents<br />Pedophilia is rare, but not unheard of, in females<br />Associated Features<br />Most pedophiles and incest perpetrators are male<br />Incestuous males may be aroused to adult women<br />Pedophiles are not aroused by adult women<br />Most rationalize the behavior<br />Engage in other moral compensatory behavior (church) <br />
  • 20. Pedophilia: Medical Treatment<br />Medications: The Equivalent of Chemical Castration<br />Often used for dangerous sexual offenders <br />Types of Available Medications<br />Cyproterone acetate – Anti-androgen, reduces testosterone, sexual urges and fantasy<br />Medroxyprogesterone acetate – Depo-provera, also reduces testosterone<br />Triptoretin – A newer more effective drug that inhibits gonadtropin secretion<br />Efficacy of Medication Treatments<br />Drugs greatly reduce sexual desire, fantasy, arousal<br />Relapse rates are high with medication discontinuation<br />
  • 21. Paraphilias: Causes and Assessment<br />Associated with sexual and social problems and deficits <br />Inappropriate arousal / fantasy learned early in life <br />High sex drive plus suppression of urges / drive<br />Psychophysiological Assessment of Paraphilias<br />Deviant patterns of sexual arousal<br />Desired sexual arousal to adult content<br />Social skills and the ability to form relationships<br />
  • 22. Gender identity disorder<br />
  • 23. Strong, persistent identification w/ other sex<br />Persistent discomfort w/ sex, inappropriateness in gender role.<br />Person feels trapped in the body of the wrong sex<br />Assume identity of the desired sex<br />Male to female or female to male.<br />The goal is not sexual<br />Causes are Unclear<br />Gender identity develops early – 18 and 36 months/age <br />As child<br />Cross dressing<br />Cross sex roles<br />Played w/ other sex<br />Insisting is other sex<br />
  • 24. Sex-Reassignment Surgery<br />Who is a candidate? – Basic prerequisites before surgery <br />75% report satisfaction with new identity<br />Adjustment is better for Female-to-male conversions .<br />It is very expensive, and takes years of preparation and<br />maintenance, both biological and psychological.<br />Psychosocial Treatment of Gender Identity Disorder<br />Realign psychological gender with biological sex<br />Few Large Scale Studies.<br />Male to female transgendered people cannot bear children, and can have prostate cancer and other ‘male’ problems. <br />However, transgendered people can have successful intimate and sexual relationships, they do have orgasms following gender reassignment.<br />Medical treatment<br />
  • 25. Sexual orientation<br />Heterosexual<br />Homosexual<br />Bisexual<br />Not in DSM-IV<br />
  • 26. A portion of all sexual disorders can be prevented through education alone, but because our society generally shies away from providing such education, people end up with problems in sexual functioning. <br />Additionally, we assume that sexual activity is ‘natural’ and that no education is necessary. This is not true, we all have to learn part of what successful sexual encounters entail.<br />
  • 27. Thank you<br />

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